Do You Need That Test?

Unnecessary medical tests are inflating your billsand may even be endangering your health. A 2006 study in the American Journal of Preventive Medicine found that in 43% of routine checkups of outwardly healthy people, doctors ordered an X-ray, electrocardiogram, or urinalysistests that are not recommended for routine prevention under national guidelines.

"There is harm in extra tests, such as exposure to radiation," says Daniel Merenstein, MD, the director of family medicine at Georgetown University and the lead author of the study.

Besides causing stress, excessive testing can eat up funds or insurance coverage. Dr. Merenstein says that in one recent case, a couple had an extensive infertility workup costing thousands of dollars, even though they had been trying to conceive for only six months. (Medically, infertility is defined as trouble conceiving for at least one year.)

"In another study, we found doctors in the Washington, D.C., area were overusing colonoscopiesdoing them every 5 years instead of every 10 as guidelines recommend," Dr. Merenstein says, referring to the recommended interval for people whose colonoscopies show no abnormalities. Colonoscopies, which range in cost from $650 for a simple procedure to $2,000 or more if they include biopsies, are important for detecting colon cancer, but they do carry risks of complications, such as bleeding and bowel perforation.

Superfluous tests arent always the doctors idea. Bob Phillips, MD, director of the Robert Graham Center, a Washington, D.C.–based research center that studies policy in family practice and primary care, had one 70-year-old patient who asked him to do a prostate specific antigen (PSA) test for prostate cancer. The results were normal, but the man was consumed with worry because his father had suffered from the condition. He sought a second opinion from a urologist, who repeated the PSA on account of this family history. Although the second PSA showed no increased risk for cancer, the urologist recommended a blind biopsy. Sure enough, cancer was found, and the man had his prostate removed, a procedure which left him impotent and incontinent.

"At that point, he came back to me very upset about the side effects, and asked me, 'Did I do the right thing?'" says Dr. Phillips. "By age 70, half of men will have prostate cancer, but most dont end up dying of it. I felt just terrible for him. Theres a good chance he would have lived his life without any ill effects from the cancer."

Question why a test is being done
If your doctor orders an MRI, CT scan, or other medical test, speak up. "Ask why its being ordered, what will be done afterward if the results are positive (or negative), and what your risk factors are," says Dr. Phillips. If the answer is simply, "routine screening," the test may be unnecessary. The doctor should have specific reasons, he says.

Some blood tests, such as the complete blood count (CBC), are sometimes done too often. While not dangerous, the costs can add up, especially if you get them several times. "The main thing is, ask your doctor, 'Do I really need this test?'" says Dr. Merenstein.

[ pagebreak ]Organize your medical recordsand share them with all your providers
One reason for unnecessary tests is scattered record keeping. "It helps if your doctor has electronic medical records," says Dr. Phillips. "Frequently, blood tests are repeated because doctors dont know a test has already been done or because they cant put their hands on the results. And if youre also seeing a cardiologist, an endocrinologist, or other specialists, youre likely to have the same test repeated two or three times."

You can avoid duplication by keeping track of your own records, including copies of EKGs, X-rays, and blood work. Ask for photocopies of lab results and carry them with you when you see specialists.

"Everyone should have one page that shows, this is my last colonoscopy, my last mammogram, my last blood-sugar test," says Dr. Merenstein.

Whenever you are referred to another doctor, Dr. Phillips suggests that you ask for your test results to be shared with other physicians: "Say, 'Heres the number for my cardiologist, can you fax my results to him?'"

Online health record services such as Microsoft's HealthVault, Google Health, and iHealthRecord offer free and easy ways to compile medical records and track prescriptions. Pay services such as MyMedicalRecords.com and FollowMe even allow you to upload and organize images of MRIs, CT scans, and X-rays, and to have them handy if you change doctors or see specialists.

Shop around for less expensive tests
When you do need to have a test done, it pays to call a few different testing facilities to compare prices. If youre paying out-of-pocket, or are worried about exhausting your health-insurance caps, you might find that the savings are considerable.

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